Premenopausal black women have a 2- to 3-fold greater rate of coronary heart disease (CHD) than premenopausal white women. The purpose of this study was to provide greater insight into the reasons for this difference, which are currently unclear. We compared CHD risk factors in 99 black and 100 white, healthy, premenopausal women, aged 18 to 45 years, and of relatively advantaged socioeconomic status. Compared with white women, black women had a higher body mass index (32.0 _ 9.2 vs 29.0 _ 9.4 kg/m2, p=0.021), and higher systolic (124 _17 vs 115 _ 14 mm Hg, p<0.0001) and diastolic (79 _ 14 vs 75 _ 11 mm Hg, p=0.048) blood pressures. The mean plasma lipoprotein(a) concentration was markedly higher in the black women (40.2 _ 31.3 mg/dl) than in the white women (19.2 _ 23.7 mg/dl, p<0.0001). The plasma total homocysteine level was also higher in the black women (8.80 _ 3.38 vs 7.81 _ 2.58 umol/L, p=0.013). The black women, however, had lower plasma triglyceride levels (0.91 _ 0.46 vs 1.22 _ 0.60 mmol/L, p<0.0001), and a trend toward higher high-density lipoprotein (HDL) cholesterol levels (1.37 _ 0.34 vs 1.29 _ 0.31 mmol/L, p=0.064) than the white women. Plasma total and low-density lipoprotein (LDL) cholesterol levels were similar, despite a greater consumption of saturated fat and cholesterol by the black women. Rates of cigarette smoking and alcohol intake were low and similar between the races. Premenopausal black women had a higher mean body mass index, blood pressure, lipoprotein(a), and plasma total homocysteine level, and a greater consumption of saturated fat and cholesterol than white women. These differences in coronary risk factors may place the black women in our study at increased risk for CHD compared with the white women. FUNDING Collaboration with Dr. Gerhard at OHSU PUBLICATIONS Gerhard GT, Sexton G, Malinow MR, Wander RC, Connor SL, Pappu AS, Connor WE. Premenopausal black women have more risk factors for coronary heart disease than white women. Am J Cardiol 82:1040-1045, 1998.